Abstract
Since the beginning of the COVID-19 emergency, the referral Intensive Care Unit for the Extracorporeal Membrane Oxygenation (ECMO) support of Piedmont Region (Italy), in cooperation with infectious disease specialists, perfusionists and cardiac surgeons, developed a protocol to guarantee operator safety during invasive procedures, among which the ECMO positioning or inter-hospital transport. The use of powered air-purifying respirators, filtering facepiece particles (FFP) 2–3 masks, protective suits, disposable sterile surgical gowns, and two pairs of sterile gloves as a part of a protocol seemed effective and feasible for trained healthcare workers and allow all the complex activities connected with the positioning of the ECMO support to be completed effectively. The simulation training on donning and doffing procedures and the presence of a dedicated team member to verify the compliance with the safety procedure effectively reassured operators and likely reduced the risk of self-contamination. From 1 March to 31 December 2020, we used the procedure in 35 severe acute respiratory distress syndrome (ARDS) patients and one acute respiratory failure caused by neoplastic total tracheal obstruction, all positive to COVID-19, to be connected to veno-venous ECMO in peripheral hospitals and centralized for ECMO management. This preliminary experience seems to confirm that the use of ECMO during COVID-19 outbreaks is feasible and the risks associated with its positioning and management are sustainable for the health-care workers and safe for patients.
Highlights
The COVID-19 ContextAt the beginning of the COVID-19 outbreak, both international and national organizations supported the plan to hospitalize suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) critical patients in contact and airborne isolation whenever possible [5,6,7]
From 1 March to 31 December 2020, we used the procedure in 35 severe acute respiratory distress syndrome (ARDS) patients and one acute respiratory failure caused by neoplastic total tracheal obstruction, all suffering from pneumonia by 2019-nCoV, confirmed by the real-time polymerase-chain-reaction (RT-PCR) on at least one low respiratory tract specimen [19]
Personnel training is essential and all Extracorporeal Membrane Oxygenation (ECMO)-related equipment needs to be practiced in simulation environment wearing protective equipment (PPE) and powered air purifying respirators (PAPRs)
Summary
At the beginning of the COVID-19 outbreak, both international and national organizations supported the plan to hospitalize suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) critical patients in contact and airborne isolation whenever possible [5,6,7]. Patients should have been admitted to single rooms with sufficient space for operators donning and doffing [8]. These strategies, used in many facilities during the SARS pandemic, could not be applied in the context of the SARS-CoV-2 pandemic. Due to the increasing number of patients, entire ICUs have to be dedicated to COVID-19 patients and others have been temporarily created and relocated outside the standard contexts
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